泰国青少年哮喘患者自我管理行为、症状控制及健康相关生活质量的调查研究

Causal relationships among self-management behaviors,symptom control,health-related quality of life and the influencing factors among Thai adolescents with asthma

目的探讨泰国青少年哮喘患者自我管理行为、症状控制、健康相关生活质量及其影响因素之间的因果关系。方法采用横断面研究设计,应用便利抽样法,共纳人泰国曼谷3所三级医院的240例青少年哮喘患者及其照顾者。2020年11月至2021年7月,通过访谈和系列调查问卷评估青少年哮喘患者健康相关生活质量、哮喘症状控制、哮喘自我管理行为、健康素养、抑郁状况、合并症、家庭支持、同伴支持、家庭环境管理以及与医疗保健提供者的关系。基于修订后的自我和家庭管理理论框架构建模型,使用描述性统计和路径分析对数据进行分析。结果所提出的模型与实证数据基本吻合,可以反映健康相关生活质量变异的67.2%。抑郁状况和哮喘症状控制直接影响青少年哮喘患者的生活质量(分别为β=-0.132,β=0.740,均P<0.05),而哮喘自我管理行为未显示有影响。抑郁和哮喘自我管理行为通过哮喘症状控制对生活质量产生间接影响(分别为β=-0.382,β=0.225,均P<0.05)。健康素养(β=0.343)、家庭支持(β=0.167)、同伴支持(β=1.163)以及与医疗保健提供者的关系(β=0.181)显示对哮喘自我管理行为有直接影响(均P<0.05)。结论研究结果证实了泰国青少年哮喘患者的症状控制、自我管理行为、抑郁和健康相关生活质量之间的因果关系。研究发现,青少年健康素养、来自家人和同伴的支持以及与医疗保健提供者的关系也会影响哮喘自我管理行为。为达到有效控制哮喘和提高生活质量的目标,应该制订促进泰国青少年哮喘自我管理的综合干预措施,还应尽早发现抑郁症状并进行有效干预。

Objective:To examine causal relationships among asthma self-management behaviors,asthma symptom control,health-related quality of life and the influencing factors among Thai adolescents.Methods:A cross-sectional study was conducted using convenience sampling.A total of 240 adolescentcaregiver dyads from three tertiary hospitals in Bangkok,Thailand was ultimately included.Interviews and self-administered questionnaires assessing health-related quality of life,asthma symptom control,asthma self-management behaviors,health literacy,depression,comorbidities,family support,peer support,home environmental management,and relationships with health care providers were administered between November 2020 and July 2021.A hypothesized model based on the revised self-and family-management framework was proposed.Data were analyzed using descriptive statistics and path analysis.Results:It was shown that the proposed model was a good fit for the empirical data and accounted for 67.2%of the variance in health-related quality of life.Depression and asthma symptom control directly affected quality of life(b?0.132,P<0.05;and b?0.740,P<0.05,respectively),while asthma selfmanagement behaviors did not.Both depression and asthma self-management behaviors had indirect effects on the quality of life through asthma symptom control(b?0.382,P<0.05;and b?0.225,P<0.05,respectively).Health literacy(b?0.343,P<0.05),family support(b?0.167,P<0.05),peer support(b?0.163,P<0.05),and relationships with health care providers(b?0.181,P<0.05)also showed direct effects on asthma self-management behaviors.Conclusion:The findings confirmed the causal relationships among asthma symptom control,selfmanagement behaviors,depression and health-related quality of life.Health literacy,support from family and peers,and relationships with health care providers were also found to influence asthma selfmanagement behaviors.To achieve effective asthma control and good quality of life,a nursing intervention promoting asthma self-management for Thai adolescents should be developed.Early detection and intervention of depressive symptoms are also suggested.